Comparative study of tramadol and diclofenac as analgesic for postoperative pain
Introduction: Postoperative pain is both distressing and detrimental for the patient. Postoperative pain may be a significant reason for delayed discharge from hospital, increased morbidity and reduced patient satisfaction.
Methods: This study is a hospital based prospective, randomized, comparative, observational study over a period of one year. For the purpose of study, patients were randomly allocated equally between two analgesic protocols for patients operated for hydrocele and inguinal hernia. Pain assessment was done by using Visual Analog Scale (VAS).
Results: In the first 24,48 and 72 hours of postoperative period, mean VAS scores differed significantly between diclofenac Vs. tramadol (p<0.001). In patients operated for hernia, in the first 24,48 and 72 hours of postoperative period, mean VAS scores differed significantly between diclofenac Vs. tramadol (p<0.001. In patients operated for hydrocele, in the first 24 hours of postoperative period, mean VAS scores differed significantly (p<0.001) but in the first 48 and 72 hours of postoperative period, mean VAS scores did not differ significantly between diclofenac Vs. tramadol.
Conclusions: Diclofenac provides effective and better analgesia in acute post operative pain than tramadol. Also, tramadol requires more frequent administration than diclofenac.
2. Rahman, M.H. and Beattie, J. Managing post-operative pain. Pharmaceutical Journal. July 2005; Vol. 275; 145-8. [PubMed]
3. Jarrett PEM. Day case surgery. Surgery 1995; 13(1): 5-7. [PubMed]
4. Wantz GE. Ambulatory hernia surgery. Br J Surg. 1989 Dec;76(12):1228-9. [PubMed]
5. Munro HM, Riegger LQ, Reynolds PI, Wilton NC, Lewis IH. Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatientstrabismus surgery. Br J Anaesth. 1994 Jun;72(6):624-8. [PubMed]
6. Moffat AC, Kenny GN, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery. Anaesthesia. 1990 Apr;45(4):302-5. [PubMed]
7. Goodman & Gilman's The Pharmacologic Basis of Therapeutics - 11th Ed.New York: McGraw-Hill; 2006.
8. Jüni P, Rutjes AW, Dieppe PA. Are selective COX 2 inhibitors superior to traditional non steroidal anti-inflammatory drugs? BMJ. 2002 Jun 1;324(7349):1287-8. [PubMed]
9. Duthie DJ. Remifentanil and tramadol. Br J Anaesth. 1998 Jul;81(1):51-7. [PubMed]
10. Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002 Jul;20(4):287-90. [PubMed]
11. Swadia VN, Shah MB. Comparative evaluation of ketorolac, tramadol and diclofenac for postoperative pain relief in minor surgical procedures Indian Journal of Anaesthesia. 1999 Oct; 43(5): 64-6. [PubMed]
12. Miller C, Newton SE. Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization. Pain Manag Nurs. 2006 Dec;7(4):148-52. [PubMed]
13. Rational use of NSAIDs for musculoskeletal disorders. Drug Ther Bull. 1994 Dec 15;32(12):91-5. [PubMed]
14. Tverskoy M, Cozacov C, Ayache M, Bradley EL Jr, Kissin I. Postoperative pain after inguinal herniorrhaphy with different types of anesthesia. Anesth Analg. 1990 Jan;70(1):29-35. [PubMed]
15. Vickers MD, Paravicini D. Comparison of tramadol with morphine for post-operative pain following abdominal surgery. Eur J Anaesthesiol. 1995 May;12(3):265-71. [PubMed]
16. Demiraran Y, Kocaman B, Akman RY. A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children. Br J Anaesth. 2005 Oct;95(4):510-3. Epub 2005 Aug 12.
17. Oxford League Table of Analgesic Efficacy [Internet]. http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/lftab.
18. White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg. 2002 Mar;94(3):577-85. [PubMed]
19. Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial. Ann Emerg Med. 1998 Aug;32(2):139-43.
20. Stubhaug A, Grimstad J, Breivik H. Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind,placebo and standard active drug comparison. Pain. 1995 Jul;62(1):111-8.